Milwaukee County

Milwaukee infant mortality rates heading in wrong direction

Troubling increases in the rate at which babies continue to die in Milwaukee before their first birthday, and especially the rate at which African-American babies die, are moving the city further away from goals it set in 2011, according to new data the city will release Tuesday.

Black infants are still about three times more likely than white infants to die in Milwaukee, and the city is in danger of not closing the racial gap of infant mortality within the next few years as multiple ongoing community initiatives battle to reverse the trend, according to Geoffrey R. Swain, chief medical officer for the Milwaukee Health Department and a professor at the University of Wisconsin School of Medicine & Public Health.

Historically, Milwaukee has had one of the highest infant mortality rates in the country. Last year, 117 babies died in the city — the equivalent of about four classrooms of schoolchildren, Swain said Monday.

"These are unspeakable tragedies," Swain said. "It's also an indication of much broader suffering in our community. These are the result in many cases of chronic stress and very difficult living conditions."

While the contributing factors to infant mortality are complex, chronic stressors within the African-American community that contribute to health problems cannot be ignored, Swain said Monday, noting that about twice as many black babies as white babies are born each year in Milwaukee.

"We have to start making the link in people's minds between social and economic conditions in our neighborhoods and the likelihood of whether babies born there live or die," Swain said. "Access to health care is important, but alone will not solve this problem. Changing individual behaviors like smoking and safe sleep alone will not solve this problem."

"Chronic stress — toxic stress — affects muscles and organs. It's not made up," Swain said. "If you're a CEO, you've got a lot of stress, but also lots of resources to manage that stress. Living in poverty with chronic, unmitigated stress and no resources to manage it wreaks havoc on your body."

When a pregnant woman faces chronic stress, stress hormones continually circulate through her body, sending a chemical message for the baby to leave the womb early, research shows. A mother's life experiences dating back to childhood also may increase the odds of preterm birth, as can chronic health conditions such as diabetes and high blood pressure; behaviors such as smoking and drinking alcohol; and a history of previous premature deliveries.

Infant mortality rates, because they involve small numbers, can bounce up and down from year to year. That's why health officials prefer to use three-year "rolling averages" to discern trends.

The city set a goal in 2011 of reducing its overall infant mortality rate by 10% and its black infant mortality rate by 15% by 2017. The goal would drop the overall rate to 9.4 deaths for every 1,000 births and the African-American rate to 12 deaths for every 1,000 births.

New city data shows the three-year rolling average for black babies dying before their first birthday climbed from 14.6 in 2010-'12 to 15.6 in 2011-'13 — an increase of about 7%. It was the fourth year in a row that black infant mortality rate went up.

The city's three-year rolling average for overall infant mortality was 10.3 deaths per 1,000 live births in 2011-'13, up about 8% compared to the 2010-'12 record low of 9.5, according to the new data. Until this year, the overall infant mortality rate measured in three-year averages had been steadily decreasing since 2004-'06.

The new city data also shows the rolling average for white infant deaths increased by about 8%, from 5.1 in 2010-'12 to 5.5 in 2011-'13.

The Hispanic rate bucked the trend, dropping from 6.0 in 2012 to 5.3 in 2013. Health officials cautioned that Milwaukee's Hispanic population is too small to determine short-term trends.

The city is still close to being on track to meet its goal of an overall infant mortality rate of 9.4 by 2017, Mayor Tom Barrett said Monday. But the 8% increase in the overall rate in the latest numbers "should send concern bells throughout the community," he said.

"Obviously in previous years, we were pleased with the progress," Barrett said. "This year, we are not pleased. The overall numbers are troubling."

Premature births

Health department officials cited three main areas they believe must be addressed to improve Milwaukee's birth outcomes: Improving individual behaviors, such as smoking and safe sleep; improving access to quality medical care before and between pregnancies, especially for women with infections, chronic conditions or prior preterm birth; and reducing "lifecourse stressors" that are considered the most important drivers of prematurity — from safe neighborhoods and fatherhood involvement to early childhood education and job preparation programs.

About 60% of infant deaths are attributed to complications of premature birth. Each year, about 1,100 babies are born prematurely in Milwaukee, according to Swain. Those who survive often have long-term disabilities.

In addition to the mortality risk, prematurity is costly to the health care system.

Costs for an uncomplicated full-term birth in 2012 totaled about $4,400; a premature birth on average cost about $54,000, Swain said.

In 2012, about 12% of pregnant women in Wisconsin had no health insurance, he said.

Swain said he's still optimistic that infant mortality rates can be brought down in Milwaukee.

"This task is not easy and it will not fix itself," he said. "We have to commit as a city to make sure our women are healthy and our communities are strong."

The community must not give up, said Magda Peck, founding dean of the University of Wisconsin-Milwaukee's Zilber School of Public Health.

"We must always be optimistic because lives are at stake," Peck said after reviewing the new city data. "This is unacceptable. It has to change. And we can do this. It's never, ever over."